Anatomy and

Physiology of the
Skin

Content Creators:
Members of the South West Regional Wound Care Program’s
Clinical Practice and Knowledge Translation Learning Collaborative

Last updated August 28, 2015

Learning Objectives
1. Develop a basic understanding of the characteristics of
the various layers of skin and its underlying structures

2. Review the primary functions of skin

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3. Understand some of the factors that may negatively
affect skin integrity

4. Reflect on the effects of aging on skin

5. Identify some preventative interventions to reducing a

persons risk of impaired skin integrity
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Photographs and Illustrations
• Images/illustrations obtained via Google Images

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STRUCTURES
SKIN AND ITS UNDERLYING

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What is Skin1?
 The body’s largest organ contributing to one sixth of the total
body weight

 Covers 20 square feet in area (adult)

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 Three primary layers:
 Epidermis
 Dermis
 Subcutaneous tissue

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Epidermis1
 The outmost/top layer of the skin (protective layer)

 Has an average thickness of 0.1mm (15-100 cell layers)

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 Avascular (no blood vessels)

 Divided into five sub layers:

 Stratum corneum
 Stratum lucidum
 Stratum granulosum
 Stratum spinosum
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 Stratum basale
Stratum Corneum
• Avascular
• Multilayer
• Barrier to environment and prevents transepidermal water
loss:

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• Dressing adhesives can strip stratum corneum and cause
transepidermal water loss
• Involved in formation of an acid mantle:
• Makes skin less
permeable to water
• Protects skin from
microorganism invasion
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 Skin pH

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Normal skin pH
(4 - 6.5)
Open wound
pH (6.5 – 8.5)

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Image: http://www.apple-cider-vinegar-benefits.com/properties-of-vinegar.html#phv
Acid Mantle
• Damage to the skin increases it’s pH and risk of infection

• Diseases/conditions associated with increased skin pH:

• Eczema

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• Dermatitis
• Dry skin
• Diabetes
• Chronic renal failure
• CVD

• Urine, stool, perspiration on the skin increases it’s pH

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Acid Mantle Continued
• To maintain acid mantle:
• Avoid adhesives
• Use mild pH balanced non-scented skin cleansers
• Use mild pH balanced non-scented moisturizers

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Epidermal Layer1
• Contains four distinct layers of cells:
• Keratinocytes
• Melanocytes
• Same number in all skin colors
• Size and activity greater in darker skin

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• Cells in dark skin more compact therefore skin more resistant to
injury
• Merkel Cells
• Langerhan Cells (immune function)

• The external layer is almost completely replaced every three

to four weeks (continually shedding and reviewing)
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Dermis1
• Immediately below the epidermis (nourishes epidermis)
• Fibroblasts, macrophages, mast cells

• Largest portion of the skin

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• Composed of two layers:
• Papillary (superficial):
• ECM
• Blood and lymph vessels
• Epithelial cells
• Connective and nerve tissue
• Muscle, fat
• Reticular (deep):
• Blood vessels
• Collagen fibers 12
• Connective tissue
Dermal Layer1
• Made up of blood and lymph vessels, nerves, sweat and
sebaceous glands and hair roots

• Often referred to as true skin

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• Functions:
• Provides tensile strength, mechanical support and protection to
the underlying muscles, bones, and organs
• Regulates temperature
• Senses the environment
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Dermal Appendages
• Includes:
• Hair follicles
• Sebaceous and sweat glands (lubricate, control pH, temperature)
• Fingernails and toe nails

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• Originates in dermis and protrude into the
epidermis

• Contribute epithelial cells for

reepithelialization
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Subcutaneous1
 A.k.a adipose or hypodermis layer

 Innermost layer of the skin, various thickness

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 Composed of fat, blood vessels, and connective tissue

 Functions:
 Anchors to deep tissue
 Regulates body and skin
temperature (insulates)
 Stores energy in the form of fat 15
 The thicker the adipose layer, the poorer the blood supply through it
THE PRIMARY FUNCTIONS OF SKIN

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Function of Skin1
 Six primary functions:
 Social interaction
 Temperature regulation
 A sensory organ for pain, temperature, and touch

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 Eliminates waste
 A protective barrier between internal organs and the external
environment
 Synthesis of Vitamin D

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Function: Social Interaction
• Psychosocial function

• Linked to:
• Body image

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• Physical attraction
• Communication

• Damage to skin can contribute to:

• Poor self esteem
• Functional limitations
• Physiologic consequences
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Function: Temperature
Regulation
• Thermoregulation accomplished through combined function
of nerves, glands, and blood vessels

• When skin exposed to cold:

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• Blood vessels constrict and blood flow reduced to skin
• Body temperature falls
• Body conserves heat

• When skin exposed to heat:

• Blood vessels dilate and blood flow increased to skin
• Body temperature rises
• Sweat production increases allowing body to cool 19
Function: Sensation
• Nerve endings in skin sense:
• Pain
• Pressure
• Temperature

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• Nerve fibers (which originate in nerve
roots in the spine), supply the skin,
a.k.a. Dermatomes

• Loss or reduction in sensation

increases risk for injury
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Function: Waste Elimination
• Excretes:
• Waste products
• Electrolytes
• Water
• Average adult looses 500mL water through skin per day

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• 2 million skin pores release water and body waste to air

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Function: Skin Barrier
• Barrier to:
• Trauma
• Bacterial invasion
• Excessive loss of fluids and protein

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• Also protects tissues and underlying structures
from injury

• Skin pigmentation protects against UV radiation

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Function: Vitamin D Synthesis
• Vitamin D assists in mineralization of bones and teeth

• Vitamin D that is synthesized in skin is transferred to other

parts of body

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 Care Program
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FACTORS THAT MAY AFFECT SKIN 24

INTEGRITY
Factors That May Impair
Skin Integrity
• Dryness

• Age

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• Nutrition

• Hydration

• Environment

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EFFECTS OF AGING ON SKIN

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The Aging Process
• Biological age does not correlate with chronological age

• The rate at which we age is dependent on:

• Our genes

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• Our environment
• How we look after our bodies
Aging Skin
• 20% decrease in dermal thickness leads to thinning of
the skin

• Epidermal-dermal papillae become flattened, increasing

susceptibility to friction and shear

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• Loss of penetrability to
substances in the environment –
irritants more readily absorbed

• Elastin fibers are lost – skin less

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Skin and the Effects of Aging
• Dermis atrophies:
• Slows wound contraction
• Increases risk of dehiscence

• Diminished dermis vascularity

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• Subcutaneous fat atrophies
(most noticeable in face, backs of hands
and shins)

• Collagen in the skin reduces (collagen

fibers become compressed)
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Skin as it Ages
• Blood vessels become thinner and more fragile causing small
hemorrhages called senile purpura

• Reduction in sweat glands and sebum resulting in decreased

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skin hydration (dry, itchy, inelastic skin)

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 Care Program
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PREVENTION OF IMPAIRED SKIN 31

INTEGRITY
Three Simple Rules
1. Keep the skin clean

2. Hydrate the skin

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3. Closely monitor the skin
Keep the Skin Clean
• When skin is clean and has been dried properly it is less likely
to develop infections or wounds

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Hydrate the Skin
• Hydration and lubrication of the stratum corneum necessary
to keep skin intact

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• Use a mild, non-scented, pH balanced moisturizer to:

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• Prevent damage to the stratum corneum
• Block penetration of substances into the skin
• Reduce transepidermal water loss
Monitor the Skin
• Check the skin at least daily (twice is better) and
report any problems IMMEDIATELY

• Look closely at:

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• Skin folds

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• Perineum
• Most common pressure areas:
• Heels
• Hips
• Sacrum
• Ischeal tuberosities
Look and Feel!
• Look for and report:
• Redness
• Blisters
• Rashes
• Open areas

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• Dark colored ‘bruised’ looking areas
• Dryness
• Unusual or new lesions
• Cracked areas
• Indentation marks that suggest socks or
clothes are too tight
• Areas that feel warmer or colder than usual
• Unusual swelling
• Anything that concerns you 36
Review
1. Characteristics of the various layers of skin and its
underlying structures

2. Primary functions of skin

Care Program
South West Regional Wound
3. Factors that may negatively affect skin integrity

4. Effects of aging on skin

5. Preventative interventions to reducing a persons risk of

impaired skin integrity
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 Care Program
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For more information visit: swrwoundcareprogram.ca 38
References
1. Sussman C, Bates-Jensen B. Wound care: A
collaborative practice manual for health
professionals. USA: Lippincott Williams &
Wilkins;2007.

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